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Hamstring Injury Physiotherapy

A hamstring injury is a very common injury especially in sports, and is often called as a "pulled hamstring".

The word "pulled muscles" is a pretty accurate description of how the muscle got injured/happened in the first place, which is the hamstring muscle was pulled or stretched beyond its maximum limits, and leads to hamstring muscle fiber tearing.

Severity is divided into 3 grades as below

grades of hamstring muscle injury

Depending on how severe your pulled hamstring muscle injury is, you may see the range of symptoms as below:

1. Grade 1 Hamstring Injury any signs of pains or strains may not be present until the activity is over. The might be cramping or tightness or pains when the hamstrings are stretched or contracted. Around or less than 1-5% muscle fibers torn
   


2. Grade 2 Hamstring Injury presents with immediate pain, more severe then the grade 1 level. It is often confirmed on stretch and contraction of the hamstring muscle. Between 10-50% (or more) muscle fibers torn.
   


3. Grade 3 Hamstring Injury this level of injury is very serious, often accompanied with burning or stabbing pain. Patients with this Grade 3 injuries usually cannot walk  due to pain and poor muscle control. In this types, the muscle is completely torn (100% rupture), and you may be able to see a large bulge or lump of muscle tissues above a depression where the tear is.
   

hamstring muscle injury risk factors

There are various proposed risk factors which may play a role in hamstring injuries: 

• Older in age age
• Previous hamstring injury
• Limited hamstring flexibility (hamstring muscle tightness, a very common condition)
  
• Increased fatigue or tired
  
• Poor core strength and/or stability
• Strength imbalance
• Ethnicity
• Previous calf injury
• Previous moderate to severe knee injury
• Osteitis pubis
• Increased quadriceps flexibility was inversely associated with hamstring strain incidence in a group of amateur Australian Rules footballers
• Players presenting certain polymorphisms, IGF2 and CCL2 (specifically its allelic form GG), might be more vulnerable to severe injuries and should be involved in specific prevention programmes
• Tight hip flexors (another very common condition)
  
• previously associated lumbar spine abnormalities.

Kicking and executing abdominal strengthening exercises with straight legs have been identified as possible contributory causes of lordosis. The anatomical reason seems to be that the iliopsoas muscle group is primarily involved in kicking and straight leg raising or straight leg sit-up exercises and contributes to strengthening this muscle'. Therefore, it is possible that certain athletic activities and training methods which exacerbate postural defects may also predispose the player to injury.

During activities like running and kicking, hamstring will lengthen with concurrent hip flexion and knee extension, this lengthening may reach the mechanical limits of the muscle or lead to accumulation of microscopic muscle damage.  There is a possibility that hamstring injuries may arise secondary to the potential uncoordinated contraction of biceps femoris muscle resulting from dual nerve supply.

Another debate is on hamstring variation in muscle architecture.Short head of biceps femoris(BFS) possess longer fascicles (which allow for greater muscle extensibility and reduce the risk of over lengthening during eccentric contraction) and a much smaller cross section area compared to Long head of biceps femoris (BFL). Whereas BFL presents with shorter fascicles compared to BFS which undergo repetitive over lengthening and accumulated muscle damage.

Excessive anterior pelvic tilt will place the hamstring muscle group at longer lengths and some studies proposed that this may increase risk of strain injury.

hamstring injury Physiotherapy starts with r.i.c.e.r.

No matter what grade the injury is, physiotherapy intervention will begin with the RICER approach to all acute injuries:

• Rest your injured hamstring muscle
  
• Ice and cold therapy to decrease inflammation and swelling
  
• Compression reduces local bleeding and inflammation
  
• Elevation above the heart level helps to improve circulation and reduces pain and inflammation
  
• Referral for physiotherapy/medical intervention
  

After the 72 hours of the RICER (early stage), and depending on the severity of your hamstring muscle injury, then we can start more active physiotherapy intervention, and this should be started as soon as possible.

Please be assured that we believe in little-to-no pain during physiotherapy, and though there may be some discomfort and fear, however, by starting active physiotherapy early, you will accelerate your recovery process by a lot.

Hamstring muscle injury physiotherapy may include:

• manual therapy
• heat therapy
• cold therapy
• ultrasound therapy and radio-frequency Indiba physiotherapy to accelerate soft tissue healing
• stretching and flexibility program
• core strengthening
• stability training
• progressive strengthening
• sports-specific conditioning
• deep tissue release (especially of tight muscles including hamstrings and hip flexors)
  

Regular maintenance with deep tissue release and sports massage will improve the performance of the hamstring as well as decrease risks of recurrence of this injury (see more advantages of regular deep tissue release and sports massage here).